Harbor-UCLA Medical Center's Department of Emergency Medicine with the cooperation of the Los Angeles and Orange Counties' Emergency Medical Services (EMS) Agencies, proposes to evaluate the success rate, complication rate and effect on outcome of prehospital pediatric airway management strategies in these large, urban EMS systems. Project objectives are as follows: 1) to compare survival rates of patients treated with prehospital endotracheal intubation (ETI) and bag- valve-mask ventilation (BVM); 2) to measure the feasibility of the incorporation of ETI into the paramedic scope of practice in an urban emergency medical services system by evaluating the success and complication rates of endotracheal intubation and BVM; by measuring the length of time these skills can be retained before retraining is needed; and by estimating the cost-per-hour per paramedic to paramedic provider agencies for continuing education of airway management skills; 3) to measure the self-efficacy of the urban paramedic in pediatric airway management skills and to evaluate whether self-efficacy is affected by length of time since training; continuing education interventions; and frequency of skills utilized; 4) to evaluate the feasibility of the use of the proposed Pediatric Utstein Guidelines for Reporting of Pediatric Advanced Life Support by measuring compliance with data elements in prehospital care records of two urban emergency medical services systems; 5) to compare patient outcomes other than survival (field scene times, pulse oximetry on arrival in the emergency department, probability of survival based on injury severity, pediatric risk of mortality and neurologic outcome (Pediatric Cerebral Performance Scale) in patients treated with prehospital ETI and BVM through prospective interviews with paramedics at the time of the patient encounter and retrospective chart review; 6) to estimate the cost-per-life-saved of the inclusion of pediatric ETI to the paramedic scope of practice; and 7) to establish a large, urban EMS research coalition. Patients less than or equal to 12 years of age who are critically ill or injured requiring prehospital airway-management are randomized to receive one of two standard airway management techniques: ETI or BVM. Success and complication rate of each airway technique are determined prospectively by phone interviews of the paramedic and receiving hospital emergency physician by study investigators and are recorded on a study data form. Logistic regression will be used to determine the effect of treatment strategy on patient outcome. Finally, the cost-per-life-saved of the inclusion of pediatric ET to the paramedic scope of practice will be determined.